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TRAINING PACKAGE ON MEASLES CONTROL/ MEASLES MORTALITY REDUCTION, AFRICA/ NOSOCOMIAL MEASLES TRANSMISSION/ LESSONS LEARNED FROM MEASLES CAMPAIGNS

Wednesday, 25th of November 2009

CSU 74/2009: FOUR ON MEASLES
 
 The Measles Initiative is a partnership committed to reducing measles
 deaths globally. Launched in 2001, the Measles Initiative-led by the
 American Red Cross, the United Nations Foundation, the U.S. Centers for
 Disease Control and Prevention, UNICEF and the World Health
 Organization-provides technical and financial support to governments and
 communities on vaccination campaigns worldwide.  After more than a year's
 worth of work, the Measles Initiative has re-launched
 www.MeaslesInitiative.org . The new design features improved navigation,
 enhanced internal search engine capabilities, a comprehensive multimedia
 library and interactive map. We've also added a substantial amount of
 updated content to better showcase this public health partnership's work
 around the world. We encourage you to visit the site to learn how the
 Measles Initiative is helping reduce global measles deaths as well as to
 access journal articles, presentations and campaign reports.
 
 
 1)  TRAINING PACKAGE FOR MEASLES CONTROL
 
 From James Cheyne, PATH, comes the news of a new training tool for measles
 control.
 
 A new online tool for Strategic Planning for Measles Control
 
 The Advanced Immunization Management (AIM) e-Learning website has recently
 launched a new module to support the World Health Organization's
 computer-based Measles Strategic Planning (MSP) tool. The MSP was developed
 to help countries develop measles vaccination strategies to meet their
 measles control goals given resource limitations.  The Measles Strategic
 Planning tool is ready for use – loaded with country-specific data that can
 be updated by the user.
 The module can be used to:
 ·      Serve as a technical resource about measles
 epidemiology and vaccination strategies.
 ·      Download WHO’s MSP tool and guide users on how to run
 the tool and interpret its results.
 ·      Inform and defend a measles vaccination strategy based
 on current population susceptibility to measles and
 vaccination cost and management limitations.
 ·      Help decision-makers and donors compare the estimated
 costs and impacts of different measles control strategies at
 the national level and, for India, at the state level.
 ·      Access resources for further study in measles control.
 Developed by WHO, PATH and partners, the MSP module provides information on
 disease characteristics and epidemiology that is critical for formulating
 effective measles control strategies. Users can review the costs and
 practical implications of measles vaccination programs and test their
 understanding with a case study using the WHO Measles Strategic Planning
 Tool.  The e-Learning module and planning tool are primarily aimed at
 immunization program managers but will also be useful for country level
 program officers, health care providers, public health educators, and
 public health managers.
 The module on Strategic Planning for Measles Control can be found on
 http://aim.path.org/en/measles/index.html
 
 The module is also available on CD upon request to info@aim.path.org.
 
 The broader Advanced Immunization Management e-Leaning site also has
 modules on:
 ·      Meningitis A vaccine (also in French)
 ·      Rotavirus vaccine
 ·      Hepatitis B vaccine (also in French and Russian)
 ·      Japanese encephalitis vaccine
 ·      Immunization financing (also in French, Russian and
 Bahasa Indonesia). and
 ·      an Excel tutorial (also in French)
 
 The AIM homepage is www.aim.path.org
 
 
 2)     MEASLES MORTALITY REDUCTION IN AFRICA
 
 In this recent article from The Lancet, reproduced below, Biellik
 and Brown argue for use of simplified new serology tests to permit
 more accurate assessment of susceptibles in populations. This, in
 turn, would permit governments and partners more accurately to
 assess the correct interval between successive national measles
 campaigns.
 
 3)     THE PREVENTION OF NOSOCOMIAL MEASLES TRANSMISSION
 
 Perhaps it is time to update this 1997 article on nosocomial measles
 transmission. Full text is at
 http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=9342896
 
 The abstract: “As a result of the highly contagious nature of measles
 before the onset of rash, nosocomial transmission will remain a threat
 until the disease is eradicated. However, a number of strategies can
 minimize its nosocomial spread. It is therefore vital to maximize awareness
 among health care staff that an individual with measles can enter a health
 facility at any time and that a continual risk of the nosocomial
 transmission of measles exists. The present review makes two groups of
 recommendations: those which are generally applicable to all countries, and
 certain additional recommendations which may be suitable only for
 industrialized countries."
 
 4) What is the 10th lesson I have omitted?
 
 Ten Lessons learned from African Measles Campaigns
 
 The following conclusions are drawn from a review of 2008 and 2009 campaign
 experiences in Cote d’Ivoire, Kenya, Mozambique, Rwanda, Tanzania, and
 Uganda.
 
 1.      There is, in some settings, a 10 percent measles SIA coverage
 difference between districts with and without house visiting
 (Nampula, Mozambique in 2008 and Kenya, 2009).
 2.      Targeting of districts is best done by manual spreadsheet
 analysis of district returns from the most recent datasets, based,
 for example, on BCG minus measles, yielding the number of
 undervaccinated infants in each district (Kenya, Rwanda, Tanzania,
 Uganda). This sidesteps denominator problems by comparing only
 numerator data across districts.
 3.      Well planned campaigns can go awry when rumors are
 disseminated quickly by modern mass media (the praziquantel stories
 disseminated from one district of Tanzania, affecting performance in
 the whole country)
 4.      Urban areas do not reliably outperform rural areas in SIAs.
 In fact, the reverse is sometimes true (74 percent in Dar es Salaam
 during the SIA; 87 percent, lowest in the country, in Kigali for
 precampaign routine). Urban areas may require special attention, both
 in terms of areas to be targeted for the campaign and in terms of
 close follow-up (Kampala, Kigali, Nairobi).
 5.      Good precampaign social mobilization, coupled with failure to
 preposition all supplies on the day before the campaign, is a lethal
 mix (Kampala). Hundreds of mothers are left waiting for noontime
 deliveries of supplies which should have been there the previous
 night.
 6.      An imprest fund for unanticipated expenditures is useful
 (municipality charges for hanging banners in Kampala and Nairobi)
 7.      House visiting tends to have an impact. The impact is
 probably greater in large cities, where traditional village authority
 structures are absent.
 8.      Linkage of measles vaccination to LLIN distribution tends to
 raise vaccination coverage in some settings (Ivoirian coverage data
 from LLIN and non-LLIN districts).
 9.      The newest kid on the block, SMS messaging for social
 mobilization, remains unevaluated (Uganda).
 
 Good reading.
 
 BD